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An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group

Lookup NU author(s): Professor Vijay KunadianORCiD



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2020.

For re-use rights please refer to the publisher's terms and conditions.


The article has been co-published with permission in the European Heart Journal and EuroIntervention. All rights reserved. © 2020 the Author(s). These articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.This consensus document, a summary of the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), appraises the importance of ischaemia with non-obstructive coronary arteries (INOCA). Angina pectoris affects approximately 112 million people globally. Up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease, more common in women than in men, and a large proportion have INOCA as a cause of their symptoms. INOCA patients present with a wide spectrum of symptoms and signs that are often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. INOCA can result from heterogeneous mechanism including coronary vasospasm and microvascular dysfunction and is not a benign condition. Compared to asymptomatic individuals, INOCA is associated with increased incidence of cardiovascular events, repeated hospital admissions, as well as impaired quality of life and associated increased health care costs. This consensus document provides a definition of INOCA and guidance to the community on the diagnostic approach and management of INOCA based on existing evidence from research and best available clinical practice; noting gaps in knowledge and potential areas for further investigation.

Publication metadata

Author(s): Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, Prescott E, Karam N, Appelman Y, Fraccaro C, Buchanan GL, Manzo-Silberman S, Al-Lamee R, Regar E, Lansky A, Abbott JD, Badimon L, Duncker DJ, Mehran R, Capodanno D, Baumbach A

Publication type: Article

Publication status: Published

Journal: European Heart Journal

Year: 2020

Volume: 41

Issue: 37

Pages: 3504-3520

Print publication date: 01/10/2020

Online publication date: 06/07/2020

Acceptance date: 01/06/2020

Date deposited: 19/02/2021

ISSN (print): 0195-668X

ISSN (electronic): 1522-9645

Publisher: Oxford University Press


DOI: 10.1093/eurheartj/ehaa503

PubMed id: 32626906


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